Seizures, Vomiting and Loss of Appetite

4th Pediatric Infectious Diseases Conference

ISSN 0973 - 0958

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Rakesh Kumar, Binay Ranjan, Manjul Vijay Department of Pediatrics, Katihar medical college, Katihar...

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Question
A 4 & 1/2 year old girl born to consanguineous (2 degree) parents presented with, seizures( staring look & unresponsiveness) at the age of 2 years. He was put on gardinal (but seizures recurred shifted to eptoin 3 months back 6 months later (at the age of 2 & 1/2 years), child started having episodes of vomiting nonbilious & non projectile,15-20 per day. each episode lasting for 10-12 days, for every 3-4 months initially, later every 1-2 months. He had loss of appetite and weight Development was normal. history of patient revealed death of elder sister at the age of 3 years with c/o vomiting, & suspected liver disease (reports n a) o/e----poorly built and nourished vitals--- hr 110 / min. bp 124/90 (hypertension) rr 26/min. hepatomegaly (mild) no spleen. Orther systems are normal. investigations revealed CBP--- hb 10 TLC-- 5600/cumm plt -- adequate. rft---normal. abg--- normal.uppar gi endoscopy --- mild esophagitis.barium meal f/t normal, montoux -- negative. usg abd --- mild hepatomegaly. csf --normal. ct---normal. sr ammonia, pyruvate -- normal. lactate--- elevated(twice upper limit) urinary VMA and urinary protoporphyrinogen negative. please suggest further investigations, diagnostic dilemma and management.
Answer
Rule out pancreatitis. Also do H.pylori stool test. What is the CT scan report is of the brain or the abdomen? If not done brain CT, rule out brain tumor. Also do blood gases to rule out metabolic acidosis and barters syndrome. Back to All Questions

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